Provider Payment Policies

Providers can learn more information about our payment policies below.

Effective Date

10/1/2019

10/1/2019

10/1/2019

10/1/2019

Description

Guidelines on the use of diagnosis codes and modifiers for conditions that occurs on the left or right, or bilaterally.

CMS guidelines on E&M services on a single date of service

CMS and AMA/CPT guidelines that define new patients

Billing guidelines for the provision of services in a facility setting

Effective Date

8/15/2019

8/15/2019

8/15/2019

8/15/2019

8/15/2019

Description 

Guidelines on procedures in addition to the primary procedure.

Coding of sequela ICD-10 codes requires 2 ICD-10 codes.

Manifestation codes cannot be the only diagnosis on the claim.

Duplicate claim definition and processing rules.

Use of procedure code definitions and descriptors to guide appropriate coding.